INTERDISCIPLINARY PERSPECTIVES ON THE INTERSECTION OF CANCER AND COGNITIVE DECLINE

Abstract The population of older cancer survivors in the United States is rapidly growing. The long-term cognitive aging of older cancer survivors is not well understood, as large-scale epidemiological studies often show a paradoxical inverse association between cancer history and subsequent dementia; yet cancer survivors often experience cognitive impairment symptoms in the short-term following treatment. Further, the cancer diagnosis and care experiences of older adults experiencing cognitive impairments or dementia warrant further investigation as these are important issues for health care quality and equity amongst older adults experiencing cognitive limitations who are at risk for cancer. The novel findings presented in this interdisciplinary symposium will help to clarify the cognitive aging experiences of older cancer survivors, using innovative data sources. First, Brown will discuss the relationship between cancer and subjective cognitive decline, using the nationally representative Behavioral Risk Factor Surveillance System data. Second, Westrick will present the associations between cancer treatment types and subsequent mortality and cognitive decline for survivors of breast, prostate, and kidney cancer among Medicare beneficiaries in the nationally representative US Health and Retirement Study. Third, also using data from Medicare beneficiaries in the US Health and Retirement Study combined with a mixed-methods physician survey, Mullins will discuss differences in cancer treatment recommendations and receipt for older adults with a pre-existing cognitive impairment who are diagnosed with cancer. Finally, Todorova will take a deeper dive into the potential mechanisms linking cancer treatment with cognitive decline, by examining a biomarker of inflammation and cardiovascular toxicity among patients receiving doxorubicin. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Cancer and Aging Interest Groups.


EMERITI PROFESSORS' INTERGENERATIONAL CONNECTION: QUALITATIVE RESEARCH EXPLORING PERCEPTIONS AND SATISFACTION
Karen Devereaux Melillo, Ramraj Gautam, Lisa Abdallah, and Patcharee Wangwun, University of Massachusetts Lowell, Lowell, Massachusetts, United States UMass Lowell, designated an AFU in 2019, launched AFU Inventory and Climate Surveys in 2020; respondents identified "involving retired faculty in university activities' (AFU Principle 9) as an area for improvement.A follow-up study, guided by the PEACE Model (Levey, 2018), was undertaken to reduce students' negative stereotypes about older adults and promote positive experiences through active engagement with professor emeriti.One study objective was to explore the experiences of emeriti professors' in engaging online with Intro to Gerontology students in a novel intergenerational classroom activity.Emeriti professors met twice for one hour each with a group of 4-5 students.Following the activity, emeriti professors were invited to participate in one-hour qualitative interviews.The purpose was to explore their perceptions of, and satisfaction with, the experience in having engaged online with students.Nine of the 12 emeriti professors agreed to participate.The Zoom interviews were conducted December 2022 and January 2023 by two researchers.Qualitative content analysis coding was carried out individually by four researchers, who then met in pairs of two, followed by all four reaching consensus on identified themes.The findings revealed six major themes: enriching the IGL experiences; passion for teaching and interacting with young people; transition to and life after retirement; impact of COVID on engagement; university role in connecting with and engaging emeriti; and satisfaction with values and ideas expressed in IGL activities.These themes offer guidance in promoting AFU principle 9 through a novel intergenerational activity that benefits emeriti professors, students and universities.

INTERDISCIPLINARY PERSPECTIVES ON THE INTERSECTION OF CANCER AND COGNITIVE DECLINE
Chair: Judith Carroll Co-Chair: Lauren Stratton Discussant: Brent Small The population of older cancer survivors in the United States is rapidly growing.The long-term cognitive aging of older cancer survivors is not well understood, as large-scale epidemiological studies often show a paradoxical inverse association between cancer history and subsequent dementia; yet cancer survivors often experience cognitive impairment symptoms in the short-term following treatment.Further, the cancer diagnosis and care experiences of older adults experiencing cognitive impairments or dementia warrant further investigation as these are important issues for health care quality and equity amongst older adults experiencing cognitive limitations who are at risk for cancer.The novel findings presented in this interdisciplinary symposium will help to clarify the cognitive aging experiences of older cancer survivors, using innovative data sources.First, Brown will discuss the relationship between cancer and subjective cognitive decline, using the nationally representative Behavioral Risk Factor Surveillance System data.Second, Westrick will present the associations between cancer treatment types and subsequent mortality and cognitive decline for survivors of breast, prostate, and kidney cancer among Medicare beneficiaries in the nationally representative US Health and Retirement Study.Third, also using data from Medicare beneficiaries in the US Health and Retirement Study combined with a mixed-methods physician survey, Mullins will discuss differences in cancer treatment recommendations and receipt for older adults with a pre-existing cognitive impairment who are diagnosed with cancer.Finally, Todorova will take a deeper dive into the potential mechanisms linking cancer treatment with cognitive decline, by examining a biomarker of inflammation and cardiovascular toxicity among patients receiving doxorubicin.This is a collaborative symposium between the Alzheimer's Disease and Related Dementias and Cancer and Aging Interest Groups.

RECEIPT OF CHEMOTHERAPY AND COGNITIVE DECLINE AMONG MEDICARE BENEFICIARIES IN THE US HEALTH AND RETIREMENT STUDY
Ashly Westrick 1 , Mohammed Kabeto 2 , and Lindsay Kobayashi 1 , 1. University of Michigan School of Public Health, Ann Arbor, Michigan, United States, 2.

University of Michigan, Ann Arbor, Michigan, United States
Research on cancer and cognitive aging outcomes has been inconsistent, with clinic-based studies showing shortterm cognitive declines after chemotherapy, and populationbased epidemiological studies observing inverse associations between most cancers and subsequent cognitive aging.We aimed to determine the effect of chemotherapy on cognitive decline and mortality among Medicare beneficiaries in the population-based US Health and Retirement Study (HRS).Using data from HRS-Medicare linked participants ≥65, we identified 858 incident breast, prostate, and kidney cancer diagnoses from 2000 to 2016.Cognitive function was measured using the modified telephone interview for cognitive status (range 0 to 27).Cancer treatment (chemotherapy only, other treatments, and no treatment) was obtained from Medicare claims.We used joint modeling to simultaneously model the association between cancer treatment with cognition decline and mortality.Of 858 participants, 38.7% had breast cancer, 52% had prostate cancer, and 11% had kidney cancer.The mean age at diagnosis was 72.8 years (SD=7.62).31.7% (n=272) received chemotherapy only, 39.5% (n=339) received other treatment, and 28.8% (n=247) received no treatment.In pooled analyses, receipt of chemotherapy (vs.no treatment) was not significantly associated with cognitive decline (β: 0.08; 95% CI: -0.59, 0.76) but was significantly associated with mortality (HR: 1.39; 95% CI: 1.04, 1.88).In joint modeling, the overall hazard ratio for the receipt of chemotherapy (vs.no treatment) was 1.38 (95% CI: 1.02, 1.88).We found that receipt of chemotherapy was associated with an increased hazard of mortality, but not cognitive decline, compared to those who received no treatment.

MIXED-METHOD PILOT STUDY OF BREAST AND PROSTATE CANCER TREATMENT DIFFERENCES BY COGNITIVE STATUS
Megan Mullins 1 , Mohammed Kabeto 2 , Paul Abrahamse 2 , Sarah Hawley 2 , Deborah Levine 2 , Lindsay Kobayashi 3 , and Lauren Wallner 2 , 1. UT Southwestern Medical Center,Dallas,Texas,United States,2. University of Michigan,Ann Arbor,Michigan,United States,3. University of Michigan School of Public Health,Ann Arbor,Michigan,United Sta tes We evaluated the association of cognitive status with treatment for breast and prostate cancer in the US Health and Retirement Study (HRS) linked to Medicare claims (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016), and surveyed physicians at an NCI designated comprehensive cancer center (N= 20, response rate 52%) to explore whether treatment recommendations differ by patient cognitive status.We evaluated the association between cognitive status and treatment receipt among Medicare-eligible HRS participants aged ≥65 whose first and only cancer was breast (n=334) or prostate (n=1,210).Multivariable logistic regression was used adjusting for race, marital status, year, age, activities of daily living, instrumental activities of daily living, education, and comorbid conditions.Physicians were randomized to clinical vignettes presenting a patient with mild cognitive impairment (MCI) or normal cognition and asked their treatment recommendations for early-stage cancer via survey.Women with dementia had 80% lower odds of receiving radiation therapy compared to cognitively normal women (aOR 0.17; 95% CI: 0.03-0.87).Oncologists were less likely to recommend chemotherapy for early-stage breast cancer patients with MCI (vs.normal cognition).Prostate cancer treatment receipt and recommendations did not vary by cognitive status.Notably, 25% of breast oncologists and 40% of urologic oncologists overestimated the risk of dementia among patients with MCI, and both groups were more likely to ascertain caregiver preferences for patients with MCI.These findings suggest there may be differences in cancer treatment recommendations and receipt among patients with MCI compared to those with normal cognition, which may be in part driven by physician overestimation of dementia risk.